Expense Account Statement Form

EXPENSE ACCOUNT STATEMENT






Employee:_________________________________________________________
For period ending:________________________________________________




REIMBURSABLE EXPENSES INCURRED


Hotel/Lodging $_________________________
Meals $_________________________
Tax $_________________________
Travel (air, train, bus) $_________________________
Personal auto _____ miles x ___ cents $_________________________
Parking $_________________________
Phone $_________________________
Other (itemize):
_____________________ $_________________________
_____________________ $_________________________
_____________________ $_________________________
_____________________ $_________________________
Total: $_________________________
-------------------------


I certify the above is a true statement of incurred
expenses in accordance with company policy. Receipts are
attached.




_______________________________
Employee




Approved for payment:




By:_____________________________